Concussion Policy & Protocol

(Click link below)
Concussion Information & Inter-Scholastic Permission Form


Dominic Murray Sudden Cardiac Arrest Prevention 
Dominic Murray Prev. Act.pdf

Dominic Murray Sudden Cardiac Arrest Prevention Act.pdf
Student Parent Concussion Information.pdf

Student-Parent Concussion Information 
Student Parent Concussion Info 

   Summary of Concussion Management 
& Awareness Act
Concussion Management

Hicksville UFSD - Return to Play Following a Concussion

Any athlete suspected of having a concussion or removed from participation because of a traumatic brain injury or concussion must first have medical clearance from a physician or appropriate health care provider before beginning this clearance program.  They must move through this program regardless of the Physicians note.

The health care provider may or may not order a CT scan or MRI.  However, if these tests are performed, and are normal, that should not rule out the presence of a mild traumatic brain injury.

To further understand, if you were to drop a heavy object on your foot, in all likelihood it would result in swelling, redness and pain.  An x-ray may be negative, because there was no fracture or anatomic disruption, however, the bruise still exists resulting in pain, redness, swelling, etc... The pain and inflammation will persist, until enough time passes with limitation of activity and rest for the injury to heal, noted by the resolution of all signs and symptoms.

Once the athlete has received full medical clearance by his physician, or health care provider, the next step is an evaluation for cognitive ability and impairment.  Current data shows that inflammation resulting from traumatic brain injury alters the ability of the brain to transmit signals normally, thus resulting in cognitive impairment. When the injury has healed, transmission returns to normal, and cognitive ability returns to normal.   Ideally, it would be helpful to baseline all athletes before the season begins -this is not absolutely necessary since the computerized programs create baselines from their data base, and the scored evaluations are based on standards developed during their initial research.

It is important to recognize that the cognitive assessments currently available are extremely useful tools.  The critical aspect of this step it that a cognitive assessment is performed, regardless of which method is utilized.

Attached are the SAC – Sideline Assessment of Concussion as an example of a cognitive ability assessment that can be utilized to assess cognitive function.  Cognitive assessment should always include a review of symptoms prior to administration of the test.

(For Cognitive assessment you can use "Impact" (computerized program) or download SAC (sideline assessment of concussion) or SCAT II, and BESS (for part 3) from the internet.)

Following return of normal cognitive ability, the athlete is ready to advance to the next phase of the return-to-play protocol.

There are three sequential levels of activity which must be completed prior to return to play:

            1 – Agility, balance, and coordination

            2 – Low impact, non-strenuous, drills which should be sport relative

            3 – Full contact, strenuous drills in a practice setting

If the athlete is able to advance through the first three steps without the return of any symptoms, he may return to participation.  If, during or after activity, the athlete has a return of any symptoms consistent with a concussion, activity must cease immediately, and the parent should be notified.

Following a complete resolution of all symptoms and duration of rest suggested by the examiner, the athlete may return to activity at the beginning of the last level he was unable to complete.

Completing the 3 levels of activity symptom free completes the concussion clearance evaluation and the athlete may return to full activity.

Dr. Karl Friedman MD

Hicksville Union Free School District Physician
Physician for Long Island Football Championships, NYS Lacrosse Championships, Official in Varsity Football, Basketball and Lacrosse,  Member of Section 8 Safety Committee,  Former Member of the National Federation Sports Medicine Advisory Committee

Protocol and Procedures for Management of Sport-Related Concussion

Medical management of sports-related concussion is evolving.  In recent years, there has been a significant amount of research into sports-related concussion in high school athletes.  Hicksville High School has established this protocol to provide education about concussion for athletic department staff and other school personnel.  This protocol outlines procedures for staff to follow, managing head injuries, and outlines school policy as it pertains to return to play issues after concussion.

Hicksville High School seeks to provide a safe return to activity for all athletes after injury, particularly after a concussion.  In order to effectively and consistently manage these injuries, procedures have been developed to aid in insuring that concussed athletes are identified, treated and referred appropriately, receive appropriate follow-up medical care during the school day and are fully recovered prior to returning to activity.

In addition to recent research, two (2) primary documents were consulted in developing this protocol.  The "Consensus statement on concussion in sport – The 3rd International Conference on concussion in sport, Zurich 2008" (referred to in this document as the Zurich statement), and the "National Athletic Trainers Association Position Statement: Management of Sport-Related Concussion" (referred to in this document as the NATA Statement).

This protocol will be reviewed on a yearly basis, by the Hicksville High School medical staff.  Any changes or modifications will be reviewed and given to the athletic department staff and appropriate school personnel in writing.

All athletic department staff will attend a yearly in-service meeting in which procedures for managing sports-related concussion are discussed.


If a head injury has been sustained, please read the following guidelines carefully.

If the athlete shows any of the following signs or symptoms, or if he/she should have any other persistent complaints, please bring the athlete to the emergency room as quickly as possible for examination by a physician.

1.    Loss of consciousness
2.    Blood or clear fluid coming from ears or nose
3.    Any changes in usual personality
4.    Restlessness, irritability
5.    Sleeping more or less than usual
6.    Difficulty in walking or speaking
7.    Double vision or other changes in vision
8.    Persistent or increasing headache
9.    Nausea or vomiting
10.  Difference in pupil size
11.  Swollen eyelids or swelling behind the ears
12.  Any other persistent complaints

In addition, the athlete should follow these instructions:

3.    Take TYLENOL or ACETOMINOPHEN only under the direction of a Physician.
4.    NORMAL sleep is OKAY.

if you have any additional questions or problems, please call your athletic trainer:


The student athlete will perform light aerobic exercise on either the Stationary Bike, or Elliptical for a minimum 20 min with intensity of 70% of maximum predicted heart rate.  During this time the athlete must maintain his or her heart rate around 70% of there maximum predicted heart rate.  Their maximum predicted heart rate is determined by using a formula of 220 – (athlete's age) = maximum age predicted heart rate.  We then take the maximum age predicted heart rate and multiply that number by 0.70 which will give us your 70% heart rate maximum.  This heart rate must be maintained for 20 minutes or else the stage is incomplete.  At any time during this stage should any of the 22 signs and symptoms return the test is aborted and the subject returns to Stage I.

Max predicted Heart Rate: 220 – __________ (athlete's age) = __________________

Max predicted Heart Rate ________________ x 0.70 = ______________ (Training HR)

Student athlete's signature: _____________________________Date: _____________

Student athlete's name printed: ________________________________

Athletic Trainer's signature: _____________________________  Date: _____________

Athletic Trainer's name printed: ________________________________



During Stage 3 you will perform sport specific exercises.  These exercises are to be done at full speed.  These sport specific exercises are designed to place your body, especially your brain under heavy stress.  Being an athlete your body needs to be able to function normally under these demands to prevent injury from occurring to yourself, your teammate or even your opponent.  If at any point your signs and symptoms return the test is aborted and will return to Stage 2 once you are asymptomatic.  These exercises are done in the following order:

(3) 50 yard sprints
(10) Up downs
(10) Push-ups
(1) 20 yard Bear Crawl
(1) 30 second Bicycle crunches (Elbow to opposite knee)
(3) T-Tests
(10) Up downs
(2 MINUTES) Simon Says with distractions
Simon Says
➢    Directional cues with hand distractions- While you are chopping your feet in place, I will say a direction (Forward, Backward, Left, or right) and point in a direction.  You are to react to my verbal cue.  This is testing your neurocognitive ability.

Student athlete's signature: _____________________________ Date: _____________

Student athlete's name printed: ________________________________

Athletic Trainer's signature: _____________________________  Date: _____________

Athletic Trainer's name printed: ________________________________



During stage 4 of your return, you will perform in inpiduals at practice.  At this time you are allowed to dress in just a helmet (if sport requires one) and shorts.  You can join the team for warm-ups, and inpidual NON-Contact drills.  You are allowed to work on your foot work, as well as join the team for plays BUT there is to be NO HITTING.  Inpidual work such as working on a sled shield in football is okay.  The objective of this stage is to exercise, have coordination, and cognitive load.  At any point during this stage your signs and symptoms return you are to abort what you are doing and find the athletic trainer.  We will then discuss what you have done for that day and return you to stage 3.

Student athlete's signature: _____________________________ Date: _____________

Student athlete's name printed: ________________________________

Athletic Trainer's signature: _____________________________  Date: _____________

Athletic Trainer's name printed: ________________________________